scholarly journals The mechanical effect of the common fibers of the anterior talofibular and calcaneofibular ligaments

2021 ◽  
Vol 9 (2_suppl) ◽  
pp. 2325967121S0000
Author(s):  
Guillaume Cordier ◽  
Gustavo Araujo Nunes ◽  
Miki Dalmau-Pastor

Objectives: The subject of the lateral ankle ligament complex is a familiar one. Common fibers between the inferior bundle of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) have been described. The purpose of this study is to investigate the possibility of transmitting a force to the CFL through the inf. ATFL. Methods: An anatomical study was carried out on 12 ankles. Each specimen was dissected according to a protocol to expose the lateral ligaments. A proximal section was made in the superior and inferior bands of the anterior talofibular ligament. A device capable of measuring shifting from one point in relation to another fixed point was used. The fixed point was implanted on the calcaneus and the other part of the sensor on the CFL. Traction of 1-kilogram was applied to the inferior band of the ATFL while the device measured the shifting of the CFL in millimeters. Two measurements were taken on each specimen by two observers. Sample data and distance measurements were recorded and analyzed. Results: It was possible to analyze 12 specimens. The specimens were from 7 women and 5 men and included 6 right and 6 left ankles. The anterior talofibular ligament was identified as a two-band ligament in all cases. One ankle had a lesion on the superior band of the ATFL. Common fibers that connect the inferior ATFL and the CFL were observed in all samples of this study. The measuring device showed shifting of the CFL in each case. The first series of measurements indicated average shifting of 0.74 mm (0.46; 1.35; +/- 0.34) and a median of 0.59 mm. The second series indicated a mean of 0.60 mm (0.23 - 1.13; +/- 0.32) and a median of 0.46 mm. Conclusion: There is an anatomical connection between the inferior ATFL and the CFL that is capable of transmitting a mechanical force to the CFL when the inferior ATFL is placed in traction. Improvement in the knowledge of the mechanical properties of the lateral ligament plane helps to clarify the possibilities for surgical repairs.

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Christopher Diefenbach ◽  
Linda Dunaway ◽  
Larissa White ◽  
Gregory Lundeen

Category: Ankle Introduction/Purpose: Anatomic lateral ankle ligament reconstruction has been shown to reliably restore the functional stability of the joint. Current orthopedic literature supports accelerated rehabilitation and protected weight bearing advancement as a safe and effective means to timely patient recovery. To our knowledge, there have not been clinical outcome reports of a protocol utilizing immediate unrestricted weight bearing in a stirrup brace following single anchor lateral ligament stabilization. The purpose of this study is to report on a series of patients treated with a more progressive protocol resulting in durable ankle stability and favorable clinical outcomes. Methods: A total of 28 patients with chronic lateral ankle ligament instability who failed conservative management underwent arthroscopy and modified Brostrom-Gould lateral ligament reconstruction between 2014 and 2015 were identified. The anterior talofibular and calcaneofibular ligaments were released from the fibula and advanced using one double-loaded metallic 3.5 mm suture anchor. Immediate unrestricted full weightbearing in a stirrup brace was allowed from the first postoperative day and accelerated physical therapy was initiated at 2 weeks postoperatively. Patients were assessed preoperatively, and at a minimum 1- year follow-up, using the AOFAS Hindfoot scale and VAS pain score. Additional postoperative outcome measures included the FAOS and a custom clinical questionnaire. Range of motion, ligamentous stability and single-blinded examination with Star Excursion Balance Test (SEBT) functional testing were performed postoperatively. Complication and recurrent instability rates were also recorded. Results: Twelve patients participated in the study (8F, 4 M). Mean age at final follow-up was 49 years (21-70). Average follow-up was 21 months (16 to 26). Average satisfaction score was 94%, and all patients reported they would have the procedure again. AOFAS Hindfoot score and VAS improved significantly from preoperative to postoperative, respectively (55.6 to 89.8, 5.4 to 1.6). Average postoperative FAOS score was 80.3 (51.8-100) . No measurable difference was observed on examination of range of motion, ligamentous stability, or SEBT testing in the anterior, posterolateral or posteromedial planes of the contralateral side, respectively (61.5 to 62.2 cm, 62.4 to 64.1 cm, 56.4 to 57.6 cm). No patients reported recurrent instability. Conclusion: This study demonstrates that anterior talofibular ligament and calcaneofibular ligament advancement utilizing a single 3.5 mm anchor construct followed by immediate unrestricted weight bearing is a safe and effective protocol for the treatment of chronic lateral ankle instability. Ligamentous stability was achieved and maintained in all patients across a wide variety of patient ages and desired activity levels. Patient satisfaction was excellent. This surgical technique and postoperative protocol may help reduce surgical time and implant cost, and may facilitate a more timely return to preinjury functional level.


2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ankur Singh ◽  
Peter Gföller ◽  
Patryk Ulicki

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex. Case Report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months. Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes. Keywords: Tarsal navicular bone, fracture, anterior talofibular ligament, calcaneofibular ligament, computed tomography scan, magnetic resonance imaging scan.


2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jeong-Hyun Park ◽  
Hyung-Wook Kwon ◽  
Digud Kim ◽  
Kwang-Rak Park ◽  
Mijeong Lee ◽  
...  

We aimed to describe the location of fibular footprint of each anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), as well as their common origin in relation to bony landmarks of the fibula in order to determine the location of the fibular tunnel. In 105 ankle specimens, the center of the footprints of the ATFL and CFL (cATFL and cCFL, respectively) and the intersection point of their origin (intATFL-CFL) were investigated, and the distances from selected bony landmarks (the articular tip (AT) and the inferior tip (IT) of the fibula) were measured. Forty-two (40%) specimens had single-bundle ATFL, and 63 (60%) had double-bundle patterns. The distance between intATFL-CFL and IT was 12.0 ± 2.5   mm , and a significant difference was observed between the two groups ( p = 0.001 ). Moreover, the ratio of the intATFL-CFL location based on the anterior fibular border for all cadavers was 0.386. The present study suggests a reference ratio that can help surgeons locate the fibular tunnel for a more anatomically accurate reconstruction of the lateral ankle ligament. Also, it may be necessary to make a difference in the location of the fibular tunnel according to the number of ATFL bundles during surgery.


2008 ◽  
Vol 29 (11) ◽  
pp. 1126-1130 ◽  
Author(s):  
Kevin L. Kirk ◽  
John T. Campbell ◽  
Gregory P. Guyton ◽  
Brent G. Parks ◽  
Lew C. Schon

Background: Elongation of ligaments during early mobilization after reconstruction may be associated with decreased stability. We evaluated elongation of the anterior talofibular ligament (ATFL) before and after lateral ligament reconstruction within a physiologic range of motion with protected and unprotected, isolated dorsiflexion/plantarflexion range of motion. Materials and Methods: Six fresh frozen cadaver legs were used with the ATFL meticulously dissected. A differential variable reluctance transducer (DVRT) was spaced to span the course of the ATFL using consistent placement points based on previous reports. Elongation was measured in a load frame with protected motion of 30 degrees plantarflexion and 10 degrees dorsiflexion for the intact and sectioned ATFL and for the repaired specimen with and without protected motion. The proximal DVRT anchor point was detached for sectioning and repair of the ATFL and replaced at the same position. Testing was 1000 cycles at 1 Hz for the repaired protected specimen and 10 cycles at 1 Hz for all other stages. Results: Initial elongation in the unprotected, repaired group was significantly higher than initial elongation in the intact ( p < 0.01), sectioned ( p = 0.02), and repaired, protected ( p < 0.01) groups. Final elongation in the unprotected repaired group was also higher than final elongation in all other groups ( p < 0.01 for all comparisons). Conclusion: The use of protected range of motion of the ankle after lateral ankle ligament reconstruction was not associated with elongation of the ATFL. The ATFL elongated significantly by comparison without protected dorsiflexion/plantarflexion. Clinical Relevance: The study provides biomechanical support for the safety of early protected dorsiflexion/plantarflexion range of motion after Broström reconstruction.


2016 ◽  
Vol 45 (4) ◽  
pp. 922-928 ◽  
Author(s):  
Chul Hyun Park ◽  
Woo-Chun Lee

Background: The anterior half of the peroneus longus tendon (AHPLT) has been reported to be an effective autograft for ligament reconstruction with respect to strength and safety. However, there is little information regarding donor site morbidity after harvesting the AHPLT. Furthermore, to the best of our knowledge, there has not been a study on the isokinetic evaluation of ankle plantar flexion and eversion after AHPLT harvesting. Purpose: To evaluate the clinical and radiographic results after lateral ankle ligament reconstruction using the AHPLT. We further investigated whether harvesting the AHPLT for lateral ankle ligament reconstruction decreases the strength of ankle plantar flexion and eversion. Study Design: Case series; Level of evidence, 4. Methods: Thirty consecutive patients (31 cases) were treated by anatomic lateral ligament reconstruction using the AHPLT. For the clinical assessment, visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson-Peterson scores were evaluated preoperatively and at the last follow-up. For the radiographic assessment, talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. The peak isokinetic torques for ankle plantar flexion at angular velocities of 30 and 120 deg/s and eversion at angular velocities of 30 and 60 deg/s were measured at a minimum of 1 year after surgery. Results: The mean VAS score improved significantly from 6.4 ± 1.7 preoperatively to 1.6 ± 1.5 at the last follow-up ( P < .001). The mean respective AOFAS and Karlsson-Peterson scores improved significantly from 57.2 ± 12.8 and 66.9 ± 13.6 preoperatively to 89.0 ± 10.0 and 93.3 ± 5.7 at the last follow-up ( P < .001). The mean talar tilt angle improved significantly from 15.3° ± 6.2° preoperatively to 3.4° ± 3.0° at the last follow-up ( P < .001), and the mean anterior talar displacement improved significantly from 10.2 ± 3.3 mm preoperatively to 6.3 ± 1.9 mm at the last follow-up ( P < .001). No significant differences were observed between the uninvolved and involved legs in the mean peak torque for plantar flexion at angular speeds of 30 deg/s ( P = .517) and 120 deg/s ( P = .347) or for eversion at angular speeds of 30 deg/s ( P = .913) and 60 deg/s ( P = .983). Conclusion: Anatomic lateral ligament reconstruction using the AHPLT showed good clinical and radiographic results without a significant decrease in the peroneus longus strength. Lateral ligament reconstruction using the AHPLT may be a good surgical option for the treatment of chronic ankle instability.


2021 ◽  
Vol 14 ◽  
pp. 141-148
Author(s):  
Matthew Vopat ◽  
Alexander Wendling ◽  
Brennan Lee ◽  
Maaz Hassan ◽  
Brandon Morris ◽  
...  

Introduction. Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. However, some patients experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament reconstruction with a graft to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament reconstruction remains unknown, as surgeons vary in how long they immobilize their patients post-operatively. The aim of this review is to provide insight into early mobilization (EM) versus delayed mobilization (DM) post-operative protocols in patients undergoing primary lateral ankle ligament reconstructions to determine if an optimal evidence-based post-operative rehabilitation protocol exists in the literature. Methods. Following PRIMSA criteria, a systematic review/meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947-1/28/2020). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 3 weeks of surgery). Functional outcome scores (AOFAS, Karlsson scores), radiographic measurements (anterior drawer, talar tilt) and complications evaluated using weighted mean differences (pre- and post-operative scores) and mixed-effect models. Results. After our search, we found 12 out of 1,574 studies that met the criteria for the final analysis, representing 399 patients undergoing lateral ankle reconstruction. Using weighted mean differences the DM group showed superior AOFAS functional scores compared to the EM group; 28.0 (5.5) vs. 26.3 (0.0) respectively, p < 0.001; although sample size was small. Conversely, no significant differences were found for Karlsson functional score (p = 0.246). With regards to radiographic outcome, no significant differences were observed; anterior drawer was p = 0.244 and talar tilt was p = 0.937. A meta-analysis using mixed-effects models confirmed these results, although heterogeneity was high. Conclusions. While there were some conflicting results, findings suggest that EM post-operative protocols for patients undergoing lateral ankle ligament reconstruction may not compromise functional outcomes or post-operative stability. Because heterogeneity was high, future studies are still needed to evaluate these protocols in less diverse patient groups and/or more consistent techniques for lateral ankle ligament reconstruction.


2018 ◽  
Vol 47 (2) ◽  
pp. 431-437 ◽  
Author(s):  
Kenneth J. Hunt ◽  
Helder Pereira ◽  
Judas Kelley ◽  
Nicholas Anderson ◽  
Richard Fuld ◽  
...  

Background: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear. Hypothesis: CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model. Study Design: Descriptive laboratory study. Methods: Ten matched pairs of cadaver specimens with a pressure sensor in the ankle joint and motion trackers on the fibula, talus, and calcaneus were mounted on a material testing system with 20° of ankle plantarflexion and 15° of internal rotation. Intact specimens were axially loaded to body weight and then underwent inversion along the anatomic axis of the ankle from 0° to 20°. The ATFL and CFL were sequentially sectioned and underwent inversion testing for each condition. Linear mixed models were used to determine significance for stiffness, peak torque, peak pressure, contact area, and inversion angles of the talus and calcaneus relative to the fibula across the 3 conditions. Results: Stiffness and peak torque did not significantly decrease after sectioning of the ATFL but decreased significantly after sectioning of the CFL. Peak pressures in the tibiotalar joint decreased and mean contact area increased significantly after CFL release. Significantly more inversion of the talus and calcaneus as well as calcaneal medial displacement was seen with weightbearing inversion after sectioning of the CFL. Conclusion: The CFL contributes considerably to lateral ankle instability. Higher grade sprains that include CFL injury result in significant decreases in rotation stiffness and peak torque, substantial alteration of contact mechanics at the ankle joint, increased inversion of the talus and calcaneus, and increased medial displacement of the calcaneus. Clinical Relevance: Repair of an injured CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high-grade injuries to avoid intermediate and long-term consequences of a loose or incompetent CFL.


2014 ◽  
Vol 104 (3) ◽  
pp. 287-290
Author(s):  
Daniel Haverkamp ◽  
Daniel Hoornenborg ◽  
Mario Maas ◽  
Gino Kerkhoffs

We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries.


Author(s):  
Laura W. Bancroft

Chapter 109 discusses MRI of the ankle and foot internal derangements, namely tendon and ligament tears, osteochondral defects, and miscellaneous. Tenosynovitis may be detected anywhere in the ankle and foot, except along the Achilles tendon where a tendon sheath is absent and there is a paratenon. Tendinosis and tendon tears occur most commonly in the Achilles, posterior tibial, and peroneal tendons. Peroneal tendons may subluxate or dislocate anteriorly with superior peroneal retinacular disruption or may become transposed with intrasheath dislocations. The anterior talofibular ligament is the most commonly torn ankle ligament caused by inversion injuries. Calcaneofibular ligament tears may occur in conjunction with an anterior talofibular ligament tear. MRI is helpful in differentiating stable from unstable talar dome osteochondral defects, because of high spatial resolution of the articular cartilage and underlying bone.


2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0007
Author(s):  
Matthew L. Vopat ◽  
Armin Tarakemeh ◽  
Brandon Morris ◽  
Maaz Hassan ◽  
Pat Garvin ◽  
...  

Category: Ankle, Sports, Post-op protocol Introduction/Purpose: Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. Some patients, however, experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament repair to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament repairs remains unknown, as surgeon vary in how they balance protection of surgical repair with immobilization with the need for ankle joint mobilization to restore range of motion. The aim of this review is to provide insight into early and delayed mobilization post- operative protocols in patients undergoing primary lateral ankle ligament repairs to determine if an optimal evidence-based post- operative rehabilitation protocol exists in the literature. Methods: Following PRIMSA criteria, a meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947- 10/16/2017). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 4 weeks of surgery). Return to sport, outcome scores (AOFAS, Karlsson scores) and complications of both populations were recorded and statistically analyzed. Results: 31 out of 1,844 studies met the criteria for the final analysis, representing 1,608 patients undergoing primary lateral ligament repair. There was no statistical difference in pre-operative AOFAS scores with delayed mobilization having a score of 67.3 and early mobilization having a score of 67.6 (p<0.639). There was statistical significance in the post-operative AOFAS score comparing delayed mobilization group versus early mobilization group with 91.8 versus 98.8, respectively (p<0.001) and post- operative Karlsson scores with values of 90.0 vs. 92.2 in delayed versus early respectively (p<0.001). Return to sport in the delayed group was 11.8 weeks versus 10.9 in early (p<0.044). No significant difference was found in complication rates between groups with delayed having a rate of 3.7% and early 4.8% (p<0.389). Conclusion: Patients may benefit from early mobilization protocols after lateral ankle ligament repair. The early mobilization protocols group had improved functional outcomes and decreased time until return to sport without a difference in complications. More studies are needed to definitively evaluate early versus delayed rehabilitation protocols due to heterogeneity of the studies.


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